Non-surgical prostate cancer treatment a first in Texas

Submitted by UTMB at Galveston

Published 6:07 am, Tuesday, July 2, 2013

A new non-surgical prostate cancer treatment offered at the University of Texas Medical Branch at Galveston virtually eliminates the side effects of impotence and incontinence that can occur when patients receive the traditional treatment for prostate cancer - surgical prostate removal.

UTMB’s Chairman of Radiology Eric Walser is one of only a few physicians in the world and the only physician in Texas who performs this groundbreaking procedure. He uses an MRI to give an accurate picture of where the tumor is, then he zaps away the cancer with a laser, without removing the prostate.

This technique, known as MRI-guided laser ablation, is performed with an instrument developed at UTMB.

Screening guideline confusion

With national standards for prostate cancer screening changing so dramatically over the past year, many men are confused about what it means to have prostate cancer, whether they should be tested for it and what they should do if they test positive.

Recently, the American Urological Association released new prostate cancer screening guidelines saying men under 55 should no longer receive routine prostate screening and that men over 80 should not receive it if they have a life expectancy less than 10 to 15 years. The association determined the odds of preventing prostate cancer death with a PSA, or prostate specific antigen blood test, for men ages 55 to 69, amounted to one life spared for every 1,000 men screened over a decade.

This is on the heels of the U.S. Preventive Services Task Force’s statement last May, saying that much more harm than good was being done to men who underwent screening, biopsy and surgical removal of their prostate gland. The vast majority of prostate cancers are so slow-growing that they will never cause a problem. On the other hand, the impotence and incontinence that can result when the sensitive nerves surrounding the prostate are damaged or severed during surgery can be devastating.

The gist of all this is that the standard treatment - surgical prostate removal - causes more damage than the disease ever would.

“The problem is, most men who test positive, even if the risk is one in 1,000 of dying of prostate cancer, still just want to get it out of there,” Walser said. “You never know if you are going to be that one.”

Improved technology

In the past, there was no way for doctors to remove prostate cancer without removing the whole prostate gland. This is because imaging technology was not powerful enough to illuminate the cancer and the available laser ablation technology was not focused enough to remove the cancer without damaging surrounding tissue. But in recent years, the technology has improved significantly.

“Our approach pairs the most advanced MRI imaging to identify cancer-suspicious areas in the prostate and the most advanced laser technology to remove them, with virtually no risk of impotence or incontinence,” Walser said.

Walser, who has been performing this procedure for three years, said this new way of treating prostate cancer offers selected men much more peace of mind than active surveillance or watchful waiting, the traditional alternatives to radical treatment.

Active surveillance entails regular PSA blood monitoring and yearly prostate biopsies - an invasive procedure in which tissue is collected from about 20 different sites on the prostate each time. Watchful waiting is less invasive but requires monitoring of patient symptoms and repeated transrectal clinical exams. Neither method actually treats cancer in the prostate.

Safe and effective

MRI imaging of the prostate offers a vastly improved method around which to approach treatment. Images of aggressive prostate cancer are distinctly different in most cases from slow-growing prostate cancer. This new ability to actually take pictures over time and see what the prostate cancer looks like and how quickly and how far it is spreading offers patients a new way to make decisions.

NIH-funded clinical trials of the new MRI-guided ablation procedure so far show that it is safe and effective, with new clinical results just published online in the journal Radiology and an ongoing study being conducted at the University of Chicago’s Pritzker School of Medicine.

For those patients whose prostate cancer is large, aggressive or has spread outside of the pelvis, ablation therapy may not be the answer. In those cases, a wide range of minimally invasive surgical options are available for consideration, including advanced robotically assisted laparoscopic prostate removal and focused radiation therapy.